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Sump C, Sauley B, Patel S, Riddle S, Connolly E, Hite C, Maiorella R, Thomson JE, Beck AF. Disparities in the Diagnosis and Management of Infants Hospitalized With Inadequate Weight Gain. Hosp Pediatr 2024; 14:21-29. [PMID: 38087957 DOI: 10.1542/hpeds.2023-007188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
OBJECTIVES To evaluate the association between race and the named etiology for inadequate weight gain among hospitalized infants and assess the differences in management. METHODS This single-center retrospective cohort study of infants hospitalized for the workup and management of inadequate weight gain used infant race and neighborhood-level socioeconomic deprivation as exposures. The etiology of inadequate weight gain was categorized as nonorganic, subjective organic (ie, gastroesophageal reflux and cow's milk protein intolerance), or objective organic (eg, hypothyroidism). The management of inadequate weight gain was examined in secondary outcomes. RESULTS Among 380 infants, most were white and had a nonorganic etiology of inadequate weight gain. Black infants had 2.3 times higher unadjusted odds (95% credible interval [CI] 1.17-4.76) of a nonorganic etiology of inadequate weight gain compared with white infants. After adjustment, there was no association between race and etiology (adjusted odds ratio 0.8, 95% CI [0.44-2.08]); however, each 0.1 increase in neighborhood-level deprivation was associated with 80% increased adjusted odds of a nonorganic etiology of inadequate weight gain (95% CI [1.37-2.4]). Infants with a nonorganic etiology of inadequate weight gain were more likely to have social work and child protective service involvement and less likely to have nasogastric tube placement, gastroenterology consults, and speech therapy consults. CONCLUSIONS Infants from neighborhoods with greater socioeconomic deprivation were more likely to have nonorganic causes of inadequate weight gain, disproportionately affecting infants of Black race. A nonorganic etiology was associated with a higher likelihood of social interventions and a lower likelihood of medical interventions.
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Affiliation(s)
- Courtney Sump
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Beau Sauley
- Murray State University, Department of Economics, Murray, Kentucky
| | - Shivani Patel
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sarah Riddle
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emilia Connolly
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Partners In Health, Malawi, Abwenzi Pa Za Umoyo/Partners In Health, Neno, MW
| | - Corinne Hite
- Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - RosaMarie Maiorella
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joanna E Thomson
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew F Beck
- Cincinnati Children's Medical Center, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Medical Center, Cincinnati, Ohio
- General and Community Pediatrics, Cincinnati Children's Medical Center, Cincinnati, Ohio
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Kielt MJ, Levin JC. To Trach or Not To Trach: Long-term Tracheostomy Outcomes in Infants with BPD. Neoreviews 2023; 24:e704-e719. [PMID: 37907398 DOI: 10.1542/neo.24-11-e704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
See Bonus NeoBriefs videos and downloadable teaching slides Infants born preterm who are diagnosed with bronchopulmonary dysplasia (BPD) demonstrate a wide spectrum of illness severity. For infants with the most severe forms of BPD, safe discharge from the hospital may only be possible by providing long-term ventilation via a surgically placed tracheostomy. Though tracheostomy placement in infants with BPD is infrequent, recent reports suggest that rates of tracheostomy placement are increasing in this population. Even though there are known respiratory and neurodevelopmental risks associated with tracheostomy placement, no evidence-based criteria or consensus clinical practice guidelines exist to inform tracheostomy placement in this growing and vulnerable population. An incomplete knowledge of long-term post-tracheostomy outcomes in infants with BPD may unduly bias medical decision-making and family counseling regarding tracheostomy placement. This review aims to summarize our current knowledge of the epidemiology and long-term outcomes of tracheostomy placement in infants with BPD to provide a family-centered framework for tracheostomy counseling.
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Affiliation(s)
- Matthew J Kielt
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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Das RK, Drolet BC, Ganor O, Terhune K. Documenting the social determinants of health in pediatric ambulatory surgery. J Pediatr Surg 2023; 58:1026-1028. [PMID: 36725394 DOI: 10.1016/j.jpedsurg.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Rishub K Das
- Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Brian C Drolet
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Oren Ganor
- Boston Children's Hospital, Boston, MA, USA
| | - Kyla Terhune
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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